The November 2003 “Autism summit” conference of the Interagency Autism Coordinating Committee occupied a large lecture hall in the new
Washington Convention Center in Washington, D.C. Heads of the three
major autism advocacy organizations joined the rest of the audience to
watch presentations on research, advocacy, and education. Officials from
the National Institutes of Health (NIH), geneticists, database administrators, parents, and legislators listened to the speakers attentively and mingled in the building lobby. I had been spending a lot of time thinking about
the concept of risk as I followed the ongoing debates about the appropriate
management of the National Immunization Program (now the National
Center for Immunization and Respiratory Diseases [NCIRD]), vaccine
safety, and autism. Parents and public health officials routinely talk about
the relative risks associated with vaccines in children. One side in the debate connects the risk of developing autism with vaccines. The other side
stresses the higher risk associated with the diseases that vaccines are designed to prevent and the risk to the public health and confidence in immunization programs that could result from sustained public discussions
about autism and vaccines.

One speaker momentarily confused me by projecting a slide that divided NIH-funded projects by level of risk—“low,” “moderate,” and “high.”
In an area where studies often involve children, wasn’t risk to research subjects rigorously controlled? That was when I realized that the presentation
referred to projects “at risk” of not being completed.1 Many of the studies described in speeches and presentations were as yet unfunded, existing only as proposals and potentialities. At best, Congress had authorized

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